Medications for Bipolar Disorder

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor or according to the instructions provided. If you have further questions about medications or their potential side effects, contact your doctor.

Psychiatrists are medical doctors (MDs) with expertise in the diagnosis and treatment of disorders of mental health. They can prescribe medications for medical conditions including bipolar disorder . Some primary care doctors, who do not specialize in psychiatry, may also prescribe these medications. In less severe cases, they will treat patients in consultation with a psychiatrist.

Medications known as mood stabilizers are the mainstay of treatment used to help control the mood swings associated with bipolar disorder. Several different types of mood stabilizers are available. You may continue treatment with mood stabilizers for an extended period of time (years). Other medications are added when necessary, sometimes only for shorter periods of time, to treat acute episodes of mania or depression .

Prescription Medications

Mood stabilizers

  • Lithium

Anticonvulsants

  • Valproate (Depakote)
  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)
  • Gabapentin (Neurontin)
  • Topiramate (Topamax)

Benzodiazepines

  • Clonazepam (Klonopin)
  • Lorazepam (Ativan)

Antidepressants—Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)

Other Antidepressants

  • Bupropion (Wellbutrin)
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Mirtazapine (Remeron)

Atypical Antipsychotics

  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Ziprasidone (Zeldox)
  • Quetiapine (Seroquel)
  • Aripiprazole (Abilify)
  • Iloperidone (Fanapt)
  • Paliperidone (Invega)

Combination (atypical antipsychotic and SSRIs)

  • Olanzapine/Fluoxetine (Symbyax)
Mood Stabilizers
  • Lithium

Lithium stabilizes your mood and is often used as initial treatment for preventing manic and depressive episodes. It acts on the central nervous system and helps you to have more control over your emotions. It has been the only medication consistently shown to be effective in preventing suicide in patients with mood disorders.

Do not drink large amounts of caffeinated beverages, such as coffee, tea, and colas when you are taking lithium.

Possible side effects include:

  • Frequent urination or loss of bladder control
  • Increased thirst
  • Nausea
  • Shakiness of the hands
  • Loss of hair
  • Acne or other skin conditions
Anticonvulsants
  • Valproate (Depakote)
  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)
  • Gabapentin (Neurontin)
  • Topiramate (Topamax)

Anticonvulsant medications, such as valproate (Depakote) or carbamazepine (Tegretol), can also have mood-stabilizing effects. They may be especially useful for difficult-to-treat bipolar episodes. In some people, anticonvulsant medications are combined with lithium, or with each other, for maximum effect.

Researchers are evaluating the safety and efficacy of psychotropic medications in children and adolescents, in light of their widespread use. There is some evidence that valproate may lead to adverse hormonal changes in teenage girls. It may also lead to polycystic ovary syndrome in women who began taking the medication before age 20. Young female patients taking valproate should be carefully monitored by their doctors.

Possible side effects include:

  • Stomach cramps
  • Diarrhea
  • Change in menstrual periods
  • Nausea and vomiting
  • Loss of appetite
  • Indigestion
  • Hair loss
  • Weight loss or gain
  • Trembling of arms, hands
  • Increased risk of suicidal thinking and behavior
  • Aseptic meningitis—inflammation of the layers of tissue that surround the brain
  • Liver injury
  • Pancreatitis
  • Bone marrow suppression, which causes a decrease in blood cells
  • Rash
Benzodiazepines
  • Clonazepam (Klonopin)
  • Lorazepam (Ativan)

There are many different types of benzodiazepine medications, including clonazepam (Klonopin) and lorazepam (Ativan). They can be helpful in promoting better sleep and reducing agitation. However, since these medications can be highly addictive and lead to tolerance, they are typically only prescribed on a short-term basis or for emergencies.

Possible side effects include:

  • Drowsiness
  • Lightheadedness, particularly in elderly persons
Antidepressants—Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Citalopram (Celexa)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in depression . They may occasionally be used in the treatment of bipolar disorder, in combination with other medications.

Possible side effects include:

  • Nausea
  • Diarrhea
  • Insomnia
  • Sexual dysfunction, ranging from decreased arousal, to erectile dysfunction , and/or delayed time to orgasm
  • Serotonin syndrome, a serious medical condition caused by an overload of serotonin
  • Sedation or insomnia
  • Increase or decrease in appetite
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
Other Antidepressants
  • Bupropion (Wellbutrin)
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Mirtazapine (Remeron)

There are several other antidepressants that work in a variety of different ways and affect the concentrations of the neurotransmitters serotonin, norepinephrine, and dopamine, which are all known to be involved in the regulation of mood.

The exact mechanism of bupropion is poorly understood. But, it is thought to be mediated through norepinephrine and dopamine pathways. It is often used in patients who are depressed and unable to tolerate SSRIs. It is also sometimes used in the treatment of bipolar disorder, along with a mood stabilizer.

Possible side effects include:

  • Nausea
  • Nervousness
  • Appetite increase or decrease
  • Sedation or insomnia
  • Sexual dysfunction, not commonly experienced with Wellbutrin, but it is possible
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect

Venlafaxine (Effexor) and Duloxetine (Cymbalta) are in the class of medications called serotonin norepinephrine reuptake inhibitors (SNRIs). They work by increasing the amount of both serotonin and norepinephrine. SNRIs are considered a last option for treatment of bipolar disorder and should always be used in conjunction with a mood stabilizer.

Possible side effects include:

  • Nausea
  • Nervousness
  • Anxiety
  • Sexual dysfunction
  • Appetite increase or decrease
  • Increased blood pressure
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect

Mirtazapine (Remeron), a tetracyclic antidepressant, has a unique mechanism of action. The medication increases the release of norepinephrine from certain neurons through a complicated process.

Possible side effects include:

  • Sedation
  • Weight gain
  • Fatigue
  • Nausea
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
Atypical Antipsychotics
  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Ziprasidone (Zeldox)
  • Quetiapine (Seroquel)
  • Aripiprazole (Abilify)

In some cases, atypical antipsychotic medications, such as olanzapine (Zyprexa) and risperidone (Risperdal), are added to a medication routine to reduce manic symptoms. Quetiapine (Seroquel) has been shown to be effective in reducing the symptoms of both mania and depression in bipolar disorder.

Possible side effects include:

  • Weight gain, metabolism changes
  • Increase in cholesterol
  • Increase in blood sugar
  • Drowsiness
  • Lightheadedness
  • Constipation
  • Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect
Combination (Atypical Antipsychotic and SSRI Antidepressant)

Another medication, called Symbyax, combines olanzapine and fluoxetine (Symbyax). This has both an atypical antipsychotic and an SSRI antidepressant.

Possible side effects include:

  • High blood sugar
  • Sedation
  • Lightheadedness, dizziness
  • Change in ability to think clearly
  • Diarrhea
  • Dry mouth
  • Weight gain
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients. (Young adults may be at a higher risk for this side effect.)
Special Note

Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the harmful effects of some mood stabilizing medications on the developing fetus. If you are considering breastfeeding your baby and will be taking medication at the same time, discuss the possible risks with your doctor before you start. If possible, these discussions should take place prior to a pregnancy. New treatments that have fewer side effects are being studied.

When to Contact Your Doctor

Contact your doctor if your medication does not seem to be working or if you have any side effects that are troublesome and persistent.

Special Considerations

If you are taking medications, follow these general guidelines:

  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking your medication without talking to your doctor.
  • Do not share them.
  • Know the results and side effects of your medication. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 09/2013 -
  • Update Date: 09/30/2013 -
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